The Neurological Impact of COVID-19

While the impacts of COVID-19 are being felt in every corner of the world, learning as much as possible about it is critical to the care Nexus provides.

Nexus Health Systems knows the importance of staying current on the latest best practices for the treatment and care of those with brain injuries or neurological impairments. During a time when the widespread impacts of COVID-19 are being felt in every corner of the world, affecting every industry beyond just that of medicine, learning as much as possible about this virus is critical to the care the Nexus medical team provides.

As active COVID-19 cases decrease, Nexus Specialty Hospital has been treating patients who are recovering from the virus’s effects. But we may be treating future patients, due to a new trend depicted in recent case reports – there is growing evidence that COVID-19 can have lasting neurological impacts.

Dr. Michael J. Hall, a staff neuropsychologist at Iowa City VA Healthcare System, recently hosted a webinar on COVID-19 and its impact on neurological functioning to share his findings with the United States Brain Injury Alliance (USBIA) community in the wake of 3.8 million confirmed COVID-19 cases in the U.S. Besides the virus’s known symptoms of fever, shortness of breath, cough, and respiratory failure, Dr. Hall shared that many patients are being impacted by effects on both the peripheral and central nervous systems. Of patients with severe cases of coronavirus studied, 36% exhibited mild to severe neurological symptoms, with 45% exhibiting severe neurological symptoms (Mao et al, 2020). 33% of patients discharged from care exhibited inattention, disorientation, and poorly organized movements (Helms et al, 2020).

While there isn’t yet enough data to indicate overall prevalence rates of temporary and long-term neurologic symptoms occurring in those with COVID-19, it’s clear that those with severe cases often develop these symptoms. The coronavirus is known to cross the blood-brain barrier (BBB), much like other severe viruses such as HIV-1, syphilis, West Nile virus, and Lyme disease, raising concerns about impacts to the nervous system. Neurologic symptoms have been observed in those with and without respiratory complications.

Peripheral Nervous System Effects
Patients with COVID-19 often experience a loss of taste and/or smell, and even vision impairment. These symptoms have been known to clear over time. Nerve pain and Guillain-Barre syndrome have also been observed, as the immune system attacks the peripheral nervous system due to an acute viral infection.

Central Nervous System Effects
Of the cases observed, the central nervous system effects most often seen in COVID-19 patients included encephalitis, anoxia, seizures, and both ischemic and hemorrhagic strokes. While respiratory infections are a known risk factor for strokes, Dr. Hall posited that viral encephalitis and its inflammatory lesions in the brain may be a direct result of COVID-19.

Mechanical ventilation, used in severe cases of COVID-19, is also shown to cause both anoxia and hypoxia after damage to the lung tissue causes improper oxygen diffusion to the blood. Some COVID-19 patients may require mechanical ventilation for days or weeks. Oddly, it’s also been observed that patients with oxygen saturation levels below 70% can remain conscious when typically levels around 85% can cause loss of consciousness.

The Future of COVID-19 Treatment
Much is still unknown of the virus itself and its long-term effects, but it’s becoming increasingly clear that neurologic screening for COVID-19 patients is needed, according to Dr. Hall. The medical community has seen positive results in treating COVID-19 with steroids as part of addressing the body’s immune response, but it’s important, he says, that additional services and supports are provided to patients who experience neurological symptoms – including acute rehabilitation services, the assessment of long-term effects, and planning for care. Educating family members and both the medical and public communities of the neurological risks of COVID-19 is also critical.

The COVID-19 pandemic is still in its infancy, and while Nexus Health Systems is treating the current symptoms of the virus, we’re prepared to treat patients that may be feeling its long-term neurologic impacts in the future. In the meantime, Nexus remains dedicated to staying educated on the latest COVID-19 developments in order to provide the highest level of care to our current and future patients.

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